Provider Demographics
NPI:1164881819
Name:TIMOTHY BAKER IP
Entity Type:Organization
Organization Name:TIMOTHY BAKER IP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IND. PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-515-7897
Mailing Address - Street 1:12007 MALLARD POND DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8620
Mailing Address - Country:US
Mailing Address - Phone:614-515-7897
Mailing Address - Fax:
Practice Address - Street 1:12007 MALLARD POND DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8620
Practice Address - Country:US
Practice Address - Phone:614-515-7897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty